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Purpose While the need for preventive strategies to reduce the incidence of aspiration pneumonia has been indicated, it is also important to investigate effective training methods to improve cough function, which is associated with the development of aspiration pneumonia. This study aimed to investigate whether a 4-week home-based unsupervised cough training (CT) or inspiratory muscle training (IMT) program was effective in improving cough strength in older adults. Methods Fifty-three ambulatory older adults without airflow limitations were randomly assigned to one of three groups: a CT group ( n  = 18), an IMT group ( n  = 18), or a control group ( n  = 17). The CT and IMT groups performed home-based unsupervised training with a device for 4 weeks. Cough strength (cough peak flow), forced vital capacity, and respiratory muscle strength were assessed at the 4-week and 16-week follow-up. Intention-to-treat analyses were performed to investigate differences between the three groups using linear mixed models. Results At the 4-week follow-up, the CT group showed significant increases in cough peak flow and forced vital capacity compared with the control group, while the IMT group showed significant increases in inspiratory muscle strength compared with the cough training and control groups. At the 16-week follow-up, the CT group showed a significant increase in cough peak flow compared with the IMT group. Conclusion These preliminary results suggest that a 4-week home-based CT program may have short-term effectiveness in improving cough peak flow in ambulatory older adults. Trial registration : This trial was registered on UMIN-CTR on 01/05/2018 (UMIN000031656).

Age-related decline in skeletal muscle mass and function are risk factors for reduced walking ability. This study aimed to understand the characteristic gait parameters of presarcopenia (low muscle mass only), dynapenia (low muscle function only), and sarcopenia (low muscle mass and function), which have differing skeletal muscle characteristics. Skeletal muscle mass, grip strength, and gait parameters (walking speed, cadence, step length, step width, gait angle, foot angle, stance time, swing time, and double stance time) were evaluated in 307 older Japanese women. Low muscle function was determined by grip strength and normal walking speed. Participants were assessed and divided into the normal (60.9%, n = 187), presarcopenia (25.7%, n = 79), dynapenia (5.2%, n = 16), and sarcopenia (8.1%, n = 25) groups. When compared to the normal group, the sarcopenia group had significantly slower walking speed and shorter step length (p < 0.05); the dynapenia group had significantly slower walking speed, smaller cadence, shorter step length, wider step width, and longer stance time (p < 0.05); and the presarcopenia group showed no differences. Skeletal muscle function may therefore be more strongly related to reduced walking function in older adults than body composition factors. The decrease in walking function was most pronounced in older women with dynapenia.

Preserved ratio impaired spirometry (PRISm) is associated with an increased mortality rate; however, its characteristics have not been clearly identified in Japan. This cross-sectional study of community-dwelling older adults compared physical function between people with PRISm and those with no respiratory issues, from 2014 to 2019. We collected demographic data through interviews and measured respiratory and physical functions. We included 668 older adults (male, 23.5%; mean age, 72.8 ± 5.6 years); the prevalence of PRISm was 12%, while the prevalence of obstruction was 6.9%. Propensity score matching was used to identify control subjects with normal spirometry (n = 80) while minimizing the effects of confounders during comparisons with the PRISm population (n = 80). Compared with community-dwelling older adults with normal lung capacity, older adults with PRISm had a lower forced vital capacity (%FVC; 68.7 ± 9.1% vs. 92.5 ± 12.7%, p  < 0.001), lower core muscle endurance (sit-up test: 6.7 ± 5.8 vs. 8.7 ± 6.0, p  = 0.032), and a longer one-leg stance duration (52.4 ± 41.1 s vs. 36.4 ± 34.1 s, p  = 0.008). In multivariable logistic regression, %FVC and increased one-leg stance were independent predictors of PRISm status. The prevalence of PRISm among community-dwelling elderly Japanese exceeds that of obstructive lung disease and is associated with reduced %FVC and better performance on balance testing.

Mild cognitive impairment (MCI) is associated with a high risk of dementia. Reportedly, 54.6% of older adults with MCI fall into the pre-frailty category. However, it is unclear what differences exist in older adults with regard to their physical, psychological, and functional capacities, which depend on MCI, pre-frailty, or a combination of the two. This study aimed to examine the differences between the association between physical function, psychological function, and functional capacity by examining a combination of MCI and pre-frailty among community-dwelling older Japanese individuals. The participants in the analysis were 236 older people living in the community. They were classified into four groups, as follows: normal, MCI only, pre-frailty only, and pre-frailty/MCI; furthermore, their physical, psychological, and functional capacities were compared. In addition, a multinomial logistic regression analysis was performed using MCI and pre-frailty as dependent variables. No associated factors were identified for MCI only, and a depressive mood was only associated with pre-frailty. When pre-frailty and MCI were combined, knee extension muscle strength, fastest gait speed, the s30 s chair stand test, depressed moods, and the instrumental activities of daily living (IADL) were correlated. Our results suggest that when MCI and pre-frailty are combined, declines in both physical and psychological functions and IADL are likely to occur.

This study investigated the relationship between subjective grip strength and physical function in community-dwelling older women. Subjective grip strength was assessed using a questionnaire, and physical function and body composition were compared between groups with strong and weak subjective grip strength. Additionally, the two groups were compared in those with mild cognitive impairment (MCI) and those with normal cognitive function, respectively. The results showed significant differences in grip strength (p < 0.001), 30 s chair–stand (CS-30) test (p = 0.039), timed up-and-go (TUG) test (p = 0.027), maximal gait speed (p = 0.029), and skeletal muscle mass (p < 0.001). Older adults with normal cognitive function showed significant differences in grip strength (p < 0.001), quadriceps muscle strength (p < 0.009), one-leg standing time (p = 0.041), CS-30 (p = 0.002), TUG (p = 0.014), gait speed (p = 0.006), and skeletal muscle mass (p = 0.003). Older adults with low subjective grip strength had lower physical function and skeletal muscle mass. However, no items showed significant differences between groups among older adults with MCI. Thus, subjective grip strength is an indicator of an overall decline in physical function and a reduction in skeletal muscle mass in older adults, and cognitive function should be considered when assessing subjective grip strength in older adults.

A decline in physical function is common among elderly people who have lost both bone and muscle mass. The aim of this study was to investigate the relationship between low bone and muscle mass and physical function in elderly women of different age groups who exercise regularly. The analysis included 299 elderly women. Low bone mass was determined by a T-score of −2.5 or less, and low muscle mass was determined by a skeletal muscle mass index of <5.7 kg/m2. Physical function was measured by grip strength, knee extension strength, standing ability, gait function, and balance function. The participants were divided into four groups based on bone and muscle mass (healthy, low bone mass, low muscle mass, and low bone and muscle mass groups), and their physical functions were compared. There were no statistically significant differences in physical function between the low bone and muscle mass and the healthy groups. There were also no statistically significant differences in physical function among the four groups in the late elderly stage (75 and older). Elderly women who exercise regularly are less likely to experience a decline in physical function, even if they have reduced bone and muscle mass.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is accompanied by dyspnea on exertion due to airflow limitation caused by bronchial stenosis, with afflicted patients being less physically active. Therefore, physical activity is important for disease management. OBJECTIVES This study aimed to examine the relationships of walking and non-walking physical activities with cognitive function or physical characteristics of patients with mild COPD in a community without respiratory rehabilitation. DESIGN Cross-sectional study. DATA SOURCES AND METHODS We included 40 male patients (mean age, 75.7 ± 6.7 years) with stable mild COPD. A three-axis accelerometer was used to evaluate walking and non-walking physical activities in daily life. Cognition, respiratory function, skeletal muscle mass, limb muscle strength, exercise capacity, and health-related quality of life were assessed. RESULTS Regarding daily exercise amount (metabolic equivalents × hours; Ex), 87.5% of the participants had walking activities of 0–2 Ex, while 67.5% had non-walking activities of 1–3 Ex. Walking activity was significantly correlated with cognitive function (P < .05), walking distance (P < .01), and health-related quality of life (P < .05), but not with muscle mass. However, non-walking activity was significantly correlated with the body mass index (P < .05), muscle mass (P < .05), and walking distance (P < .01), but not with cognitive function. Moreover, the relationship between non-walking activity and health-related quality of life was weaker than the corresponding relationship with walking activity. CONCLUSION In patients with mild COPD, walking and non-walking physical activities showed different relationships with cognitive function and physical characteristics. The findings suggest that self-management of such patients requires maintenance of both walking and non-walking activities in a balanced manner.

Few studies have examined the effects of health literacy on people at risk of developing dementia; its effects on the pathogenesis of subjective cognitive decline (SCD) are particularly unclear. This study aimed to clarify the relationship between health literacy and SCD in a population of healthy community-dwelling older adults. SCD status was assessed using the Cognitive Function domain of the Kihon Checklist (KCL-CF). Health literacy, in turn, was evaluated using the Communicative and Critical Health Literacy (CCHL) scale. Global cognitive function and depressive symptoms were evaluated using the Mini-Mental State Examination (MMSE) and a five-item version of the Geriatric Depression Scale (GDS-5), respectively. Participants who were suspected of having SCD were significantly older than their non-SCD peers, and scored significantly worse on the CCHL, MMSE, and GDS-5. In addition, SCD status was found to be associated with CCHL and GDS-5 scores, as well as age, according to a logistic regression analysis. These findings suggest that low health literacy is linked to SCD morbidity in healthy community-dwelling older adults and should prove useful in the planning of dementia prevention and intervention programs for this population.

Objectives: Research on the determinants of physical activity in mildly symptomatic patients with chronic obstructive pulmonary disease is lacking. This study examined the predictors of physical activity in patients with low-risk chronic obstructive pulmonary disease. Methods: A total of 41 male patients with chronic obstructive pulmonary disease belonging to Group A of the Global Initiative for Chronic Obstructive Lung Disease were included. Regarding the objective index, the physical activity (number of steps/day and the amount of Ex (metabolic equivalent × hours)/day) of the participants was measured with a tri-axis accelerometer. In addition, regarding the evaluation index, respiratory function and dynamic lung hyperinflation were measured by a spirometer, skeletal muscle mass was measured using bioelectrical impedance analysis, skeletal muscle strength (grip and lower limb muscle strength) was measured using a dynamometer, exercise capacity was measured by the incremental shuttle walking test, and health-related quality of life was measured. Results: Significant correlations were found between the number of steps per day and age (ρ = −0.501, p < 0.01), forced vital capacity predictive values (ρ = 0.381, p < 0.05), dynamic lung hyperinflation (ρ = 0.454, p < 0.01), grip strength (ρ = 0.318, p < 0.05), and walking distance in incremental shuttle walking test (ρ = 0.779, p < 0.01), but not skeletal muscle mass, lower limb muscle strength, or health-related quality of life. A multiple-regression analysis with the number of steps per day as the dependent variable extracted only walking distance in incremental shuttle walking test, yielding a moderate single-regression equation (steps/day = −934.909 + 11.052 × walking distance in incremental shuttle walking test, adjusted R2 = 0.548, p < 0.001). Conclusion: It was suggested that the amount of physical activity of patients with low-risk chronic obstructive pulmonary disease could be predicted by walking distance in incremental shuttle walking test.

Skeletal muscle mass and muscle strength are positively correlated, but the relationship between grip strength and global muscle strength is controversial. This study aimed to clarify the changes in site-specific skeletal muscle mass by age group and determine the relationship between site-specific, age-related changes in skeletal muscle mass and physical function in community-dwelling elderly people in Japan. The participants were divided into age groups of five-year intervals (65-69 years, 70-74 years, 75-79 years, and ≥80 years) and were also categorized by sex. The skeletal muscle mass of the upper limbs, lower limbs, and trunk was measured using multifrequency bioelectrical impedance analyzers (InBody 430 (Biospace Co., Ltd., Seoul, Korea) and InBody 470 (InBody Japan Inc., Tokyo, Japan)). For physical function assessment, we measured grip strength, quadriceps strength, sit-up count, sit-and-reach distance, and standing time on one leg with eyes open and performed the timed up and go (TUG) test. The results showed that skeletal muscle mass decreased with age regardless of sex at all measured sites. Furthermore, a partial correlation analysis adjusted for age, physical constitution, and the presence/absence of exercise habits revealed that the highest correlation was between skeletal muscle mass in all sites and grip strength. Thus, monitoring grip strength may be used as a representative of systemic skeletal mass even in Japanese people.